Insulin and hypoglycemia

My cat has just been diagnosed with diabetes. He receives his first injection in the morning. I am concerned about hypoglycemia. At what point might this occur? Would it be right after the injection or could it occur hours later? Thanks!!

 

What kind of insulin are you using? They differ in time of onset and duration of activity.

Are you planning to home-test your cat's blood glucose? This is, hands down, the very best way to keep your cat safe from hypoglycemia. Most of us here test with human meters (cheaper than pet meters) and test, at a minimum, before each shot to make sure it is safe to shoot, plus additional tests during the time when the insulin is likely to be at peak activity. It may seem scary to do this at first, but we have lots and lots of tips and tricks to share to make it more manageable!

 

Most insulin takes several hours to reach its lowest point. The best way to protect your kitty is to home test. Also have things on hand in case he had a hypo... Gravy food ( like fancy feast with gravy), and honey or Karo syrup. We can walk you through home testing of you are willing to try it.

 

Thank you so much for such a prompt reply. The kind of insulin I'm using is Vetsulin. I am so afraid of hypoglycemia occurring while I'm at work. I plan to get up early enough so I can watch him for about two hours before I have to leave.

I do plan on home testing but haven't decided on which glucometer. The supplies for the AlphaTrak are soooo expensive. The vet wanted me to wait a couple of weeks before starting home testing but I'd rather not inject insulin blindly.

I will greatly appreciate any help with my new adventure.

 

Most people here use human meters precisely because of the expense of the Alphatrak strips. They are really nice to have because they are calibrated for felines and thus give a comparison to "vet" numbers, but it does get expensive to use them if you test with any frequency at all. Many people here use the Relion brand from Walmart-- strips are both relatively cheap and (if you have a Walmart handy) can be obtained any time night or day (cats, being cats, have a habit of suddenly dipping low and requiring lots of strips on weekends!).

I'd recommend starting testing as soon as you have a meter and are ready to do so. It does take a bit of time and practice to find the routine that works for you and your cat, you don't want to have to figure it all out at a time when you suspect your cat is dropping low and really really need to get a reading right away. Plus, the more data you collect on your cat's patterns and how s/he responds to Vetsulin, the more confident you will be about leaving for work for the day.

Vetsulin is one of the insulins that tends to act fast, so watching and monitoring for the first two hours is a good plan, that will give you warning if it's going to be an "active" day and you need to take action (leaving extra food out, for example). What dose does your vet want to start at?

@Chris & China has a great intro to hometesting, so I am tagging her to bring her into the conversation. And, welcome!

 

Welcome to the FDMB Paula (I'm assuming that's your name.....what's your sugarkitty's name?)

Most of us here use the Relion Confirm or Micro from WalMart....the strips are affordable ($35.88/100) and they take the tiniest sample size.

Hypo's are a concern, but by learning to home test and doing it before every shot as well as during the cycle, you'll learn how your kitty responds and will be able to keep him safe!!

Here's something I wrote up for others that needed help with testing...maybe it'll help you too!

It can be really helpful to establish a routine with testing. Pick one spot that you want your "testing spot" to be (I like the kitchen counter because it's got good light and it's at a good height....it also already blocked 2 escape routes due to the wall and the backsplash) It can be anywhere though...a rug on the floor, a table, a particular spot on the couch...wherever is good for you. Take him there as many times a day as you can and just give his ears a quick rub and then he gets a yummy (low carb) treat. Most cats aren't objecting so much with the poking..it's the fooling with their ears they don't like, but once they're desensitized to it and learn to associate a certain place with the treats, they usually start to come when they're called! Or even when they hear us opening the test kit!

You also have to remember...you're not poking him to hurt him...you're testing him to keep him safe and understand what's going on inside his body. There's just nothing better than truly understanding what's going on inside your kitty's body and with this disease, the more knowledge you have, the more power you have against it. The edges of the ears have very few pain receptors, so it really doesn't hurt them. Also, if you're nervous and tense, it's going to make your kitty nervous and tense too. As silly as it might seem, try singing! It forces you to use a different part of your brain!

It's also important to make sure his ear is warm. A small sock filled with a little rice and microwaved or a small pill bottle filled with warm water (check temp against your wrist like you would a baby bottle) works well.

When you're first starting, it's also important to use a lower gauge lancet, like 25-28 gauge. Most of the "lancet devices" come with 33 gauge lancets and they are just too tiny to start with. The bigger lancets (that are lower numbers) make a bigger "hole". As you poke more and more, the ears will grow new capillaries and will be easier and easier to get blood from...we call it "learning to bleed"

Finding the right "treat" will be a great help too! Freeze dried chicken, bonito flakes, little pieces of baked chicken...whatever low carb treat you can find that he really enjoys will help him to associate the testing with the treat! China's Achilles heel was baked chicken, so I'd bake a piece, chop it into bite sized pieces, put some in the refrigerator and freeze the rest to use as needed. It didn't take long for her to come any time I picked up the meter!

 

Thanks, Chris! (I could have just copy-pasted, but I felt funny doing that, even with attribution!)

 

I know I am still very new but if the kitty just got his first dose this morning, is there really a possibility of going into hypoglycemia? I read that the insulin has to build up a depot before it starts to reduce BG levels. Also other members that have joined, since I have, seem to have a kitty that had initial diagnosis of BG levels of 400+ including my boy. Don't get me wrong I still worried / worry about that happening as well so I did buy Karo. I am sincerely curious

 

Vetsulin is not a deposit insulin. It's an in and out. Still with either type of insulin there is always a chance.

 

What do you mean in and out? It is quick acting? Also, I gave him his first shot. It was 1 unit but now I'm worried that he didn't eat enough. He ate about an ounce of Fancy Feast Cod, Sole, and Shrimp. I opened another can in hopes of getting more calories in him but he didn't eat much of it either. Right now he is trying to sleep and I keep waking him up to make sure he's OK.

Thanks to all of you!!! It is wonderful there are people available and willing to support and guide me through this process. My knowledge of diabetes is extremely limited. I have done much research, but hearing first hand experiences is invaluable!!! I am nervous about the whole thing and fear doing harm to my precious cat, Ninja!

BTW, you spreadsheet is awesome, Janet!!!

 

Oh thanks Janet, I thought all insulins had to build a depot.

Ninja's guardian, I completely understand how you feel because I was just doing that a month ago. I drove myself crazy for the first two weeks from constantly watching my boy. I think my brain started to trick me into seeing bad signs when he was ok Just to give you another newcomer experience.
Also a trick I use if I notice he didn't eat all of his wet food meal, or enough to make me more content to give his shot, I give him a couple treats. Only had to do this a couple times but after he gets a treat it seems to trigger him to finish his meal. I think it's also his way of saying he doesn't want that flavor lol.

 

In and out means that the dose wears out over usually 8 to 10 hours for Vetsulin. There's nothing left after that. Lantus and Levemir are depot insulins meaning that the dose is stored under the skin (or similar) and is released slowly over time. At the end of 12 hours there's some residual insulin moving slowly from the depot into the bloodstream.

 

Thank you for explaining things to me. This is my first brush with diabetes human or animal so I have a lot to learn.

Yes, Yong, I do need the perspective of a newbie like myself!!!

I read your post, China, and I am very appreciative for the tips!! I just made a trip to Walmart and bought a Relion Confirm glucometer. It didn't contain Control Solution. Is that important?

One more question: Are vacations out? The vet said to board Ninja and they would take care of him. I just don't think I could do that. He's never spent the night anywhere but home.

Thanks.
Paula (Ninja's mom)

 

I'm so glad you are open to testing!!!!! It's really the only way to be sure Ninja is safe. Great name btw!

We went away for two night trips this summer and boarded at the vet. Our cat never had been boarded either but did fine. You could also hire a pet sitter who is willing. If you can get your cat into remission that makes things much easier, and fortunately that is sometimes a possibility.

Others find pet friendly hotels and take pets with them.

 

That's an interesting idea, Janet. I bet those pet friendly hotels are pretty rare. I would be afraid it would be too much stress on my poor Ninja.

 

We got our cat into remission in September and thought oh good! Well be able to travel next summer! Then my ckd cat wound up needing medicine twice a day. GREAAAAT. LOL

 

Paula,
Just my opinion but our fur babies are happiest when they are at their house. I have done a few pet sitting jobs and even when the owner offers me to bring the pet to my place to make it easier, I tell them their baby will be more happy at their place with their scents, etc. (Plus it might upset my boy) So with that I would suggest finding a pet sitter, or close friend you trust and can teach to give shots and log, who can take care of your kitties if you go on vacation. Also, there is a site called Care.com and I think they even do background checks on people who can be hired, which offer pet sitters.

 

I am praying to get Ninja into remission! That would be great! I have another cat who is around 3 years old. Maybe he will stay healthy for a few more years.

I agree, Yong. Those fur babies want to be at home, and they want to be with their families. My Ninja used to follow me everywhere. Since he's been sick he doesn't do that anymore. I am not sure I would trust anyone to take care of him. I used to have a neighbor come over to feed them when I was gone for a few days. If he hadn't gotten them in by the designated time and fed them, I was blowing up his phone. I have cameras in my house so I knew what was going on.

 

See if you can find a good friend who would be willing to learn how to test Ninja and give insulin as well as feed and clean up after your kitties. I had to go away for a week out of province when my kitty decided to start overcoming her insulin antibodies and suddenly started having much lower readings than I had previously seen making her dosing a bit of a guessing game.

I trained my friend for a couple of months before my departure to ensure that both my friend and my cat were comfortable with testing and giving/getting insulin. I stayed in touch with my friend by cell phone while away thus maintaining some control of what was happening at home as well as not leaving all the decision making to my friend. I left copious notes and instructions in case for any reason we could not communicate. It worked out like a dream come true. I never left my friend with all the responsibility and I felt like I still had some control while gone.

 

MrWorfMen, I wish I had a friend as wonderful as yours!! I don't think any of my friends would agree to that arrangement.

I am so proud of myself!! I just did my first blood glucose measurement. Unfortunately, his level was 447. He is taking 1 unit of Vetsulin twice a day. However, he has been munching all day. His water intake is very high.

 

Congratulations on getting your first test done!!!!

 

Yesssssss!!!!!!!! Well done, you!!!!
.

 

Good for you! It gets easier.

 

Congratulations on your first test! That's one of the biggest hurdles conquered!

 

Thank all of you for your support. I certainly need it. I am feeling overwhelmed and wondering if there is a light at the end of the tunnel. Ninja wouldn't eat this morning. He is showing a small amount of ketones in his urine. His urine is showing extreme amounts of glucose. I couldn't test him this morning because he kept fighting me. I still need lots of practice. I am wondering if there is anything I need to do for him while I'm waiting for the vet's office to open. Any ideas?

 

Right now, trying to get him to eat and making sure he has lots of water available is of paramount importance.

If he won't eat, you could try syringing wet food diluted down to a soupy consistency into him but be careful to give small amounts at a time at the side of his mouth so he doesn't aspirate it. If you can get enough food into him, giving insulin is also a important component to treating ketones. A consult with the vet is definitely in order. Ketones need to be dealt with quickly before they advance into DKA which is a very expensive and dangerous condition.

The vet should check Ninja for an infection and he may need IV fluids because despite drinking so much, they still do get dehydrated. You can check Ninja by pulling up the skin on the scruff and seeing whether it snaps right back into position or if it takes a moment to settled back down. If Ninja has an infection, that would likely contribute to the high BG.

 

Thank you, Mr. Worfmen's Mom! I was hoping someone would tell me what I could do immediately. He has an appointment at 10:30. Nerve wracking......

 

You are testing for ketones and have caught this early so Ninja is very lucky to have you and he will be fine. You're doing everything you can but unfortunately despite best efforts our kitties sometimes have a set back. It's quite possible Ninja has a urinary tract infection, very common with diabetics due to the sugar in their urine and that can trigger off ketones especially when you are in the early days and still trying to get the BG under control.

 

My vet had a flying fit when I told her I was testing my cat with a blood glucose monitor. She says that it is a waste of time because it takes at least two weeks to be able to makes sense of the readings because his glucose is still out of control. She says I am stressing myself and my cat, and not to use it until after the blood glucose curve is done.

 

OK pardon me for this outburst but YOUR VET IS OUT TO LUNCH! All data is good data and the data you get at home is far more accurate than the testing she does in her office. Doing curves in the vet office and deciding dose based on those readings has more times than I care to count, caused both the cat and caregiver a lot of distress fighting back a seeming lack of response to insulin or worse, hypoglycemia. What you do at home is entirely up to you so just ignore her on the testing front. I know you want to trust your vet and you can within reason but most vets have not treated that many diabetic cats and it's abundantly clear she is not up to date on the most current guidelines all of which recommend home testing. I'm attaching a couple of documents you might want to share with your vet.

So what did she say about the ketones? Did she do anything or just throw a fit?

 

And my vet told me on the very first visit with Morris that I needed to get a meter and home test. He also said that it is useless to do a curve at the vet because the stress will cause higher BG numbers there.

 

But maybe in your vet's defense... just the time I have been on FDMB I read newbie posts where people have not learned yet that you don't respond to a single number. I've read posts where the person is wanting to increase insulin without regard to whether it is a bounce number or food influenced. All the person sees is a high number and they desperately just want to get that number down. Maybe your vet has had to deal with clients such as that.

 

I'm sure that is true, Pati. She really should have been a little more calm in stating her opinion. I usually understand what is being said to me without anger entering into the situation. I was just stating fact as we were discussing the situation with ketones in his urine. I certainly did not suggest his insulin should be raised. . . . . .that scares me to death. I am seriously afraid of hypoglycemia!!!

MrWorfMan's Mom, the vet really didn't have much to say about the ketones and didn't really seem interested. Her main interest was the glucose meter. After she finished her tirade, I mustered up the courage to ask about the ketones and she said his bladder was too small at the moment. As a final thought before I left, I asked her about maybe using needles that weren't quite so long. She raised her eyebrows and said, "All you have to do is make a tent and stick it in." End of conversation. Wow!! I'm still shaken by the vet visit.

 

Ok I know I blew a gasket. I shouldn't have and I apologize. Please don't be miffed with your vet. Maybe as Pati says, she's had a bad experience in the past with someone home testing. I was apologizing to my vet one day for asking so many questions when she confessed that some days her job makes her feel manic depressive. One minute she is dealing with a client who can't pick her brain enough and wants to know and do everything possible for their pet and the next she has someone refusing to treat a perfectly treatable condition. It's a tough life being a vet.

 

I'm so sorry you had such a bad experience with your vet.
Can you get another ketone test and let us know what the result is?
I've read about vets before that were totally not interested in ketones They don't have to pay the thousands of dollars to treat the cat for DKA.
I hope he's eating better today.

 

I have one more question. He keeps losing weight. Every time I go to the doctor he has dropped at least a couple of ounces. He is down to 7 pounds and 14 ounces from an original weight of 12 pounds. The vet doesn't seem to think it is a big deal, but I'm worried. I pick him up and he feels like I'm holding skin and bones.

 

Increase the amount of food you give him. If the vet told you to feed twice a day, feed him his main meals before his shots and then offer him some snacks in between. Just withhold food for 2 hours before his pre-shot test to make sure the test is not food influenced.
Is he usually hungry all the time? Often a diabetic cat is like an eating machine because they can't get the nutrition they need from their food. It's ok to feed him more right now and that can help keep the ketones down too. As he gets better regulated, he will start to regain the weight. When he gets back to his ideal weight you then cut back accordingly to a maintenance portion.

 

Until you get the diabetes under better control, it's hard to keep weight on them....they eat and eat but without the correct amount of insulin, the glucose never makes it into the cells to nourish them. Think of insulin like it's a "key"....and on every cell in the body there's a "lock"....without enough insulin, no matter how much the cat eats, those locks stay locked and the glucose can't get in

On a happier note, check out China's profile link in my signature.....With the help of the people here (NOT my vet), you can see how far back she came in about 4 months!!

 

That stress was the last thing you needed. I often think about how much more heartbreaking it is for you all to get a diabetes diagnosis with your beloved cat that is part of your family. I knowingly adopted a diabetic cat so I think I had it easier emotionally. I think you'll have to decide whether your vet was just having a really bad day or whether you need a vet with a better bedside manner. Honestly, I do not consult with my vet about Morris' insulin. I discovered FDMB, read every "stickee" a hundred times about my type of insulin, and read all the messages. There is a wealth of knowledge on the board and wonderful, generous people here that devote a lot of their time to helping us learn about Feline diabetes.

 

Ninja just doesn't eat much. I have wasted can after can of food trying to find one that suits his taste. The only thing he will eat consistently is yogurt--StonyField Farms Plain Organic Greek Yogurt...2% carbs. The vet said to feed him twice a day, but as thin as he is I just can't bring myself to do that! Ninja is a grazer so I just let him graze most of the day, but like you said, MrWorfMen's Mom, I withhold food for about 4 hours before insulin time.

China's before picture looks about like Ninja does now. She has really blossomed!!! You have given me hope for a better tomorrow!

Pati, you made a good point. There is a wealth of knowledge on this forum posted by people who have been through this situation. Honestly, the collective knowledge on this forum is probably way more information than any one vet ever learned in school or in their practice. I am so fortunate to have run across this forum and all the wonderful people willing to share and support others.

 

What did the vet say about the ketones? Did you test Ninja again yet? I am concerned because ketones can suddenly become a major emergency and a very expensive one so if you haven't tested again yet, I would suggest you do so ASAP.

If you are having a hard time getting Ninja to eat wet food but he will eat dry food, you could try putting some dry kibble pieces on top of the wet food or grinding some up to sprinkle on the wet. If he refuses to eat wet completely but will eat dry, give it to him. He needs to eat to keep the ketones down.

 

Me neither. I saw a new vet at my usual practice who was very impressed with the spreadsheet and Frankie's numbers and the fact that I keep his weight stable. He said the spreadsheet would be perfect if I put a "weight" column in (which I have now done) and he would never need to see Frankie again unless there was a problem. In fact, he changed Rom's insulin there and then to Lantus and he hadn't even seen him! That was how much confidence he had in me and my abilities, but that is all thanks to the wonderful people on this forum and the wealth of knowledge they have. Much more than any vet.

 

I second the advice on using a bigger lancet (lower number) 28 works for my kitty now. It's starting to get easier to take levels. I have not been testing preshot, just doing BG curves at home to save stress and money. My cat had a hypo event this weekend and we've lowered his dose. He had the first lower dose yesterday evening. This am, I decided to test because I figured that things might still be wonky with him. Thank God I tested. He was at 61. A shot of insulin this morning would have likely killed him.

 

MrWorfMen's Mom, I did do the urinalysis test strip last night and this morning and the ketones came out pretty close to negative. He was actually asking to go out this morning and I saw him chasing a squirrel. I think maybe he is ok for the time being.

That is sooo scary what almost happened to Bowie. . . . . . and my vet says no home testing for another week or so.

 

You can home test whenever you decide that you want to try it. I certainly don't want to be offensive but it's your kitty.

 

It's not fun for kitty at first, but they do get used to it, as your skill gets better. The part about growing new capillaries and getting easier draws might be helping me too. When I first started, it was kind of discouraging and I felt like a mean Mommy taking the samples, but now I feel like a semi-pro, and we've been on this journey for less than two months. It's empowering to be able to test when you think something is not right, and at this point, when the dosing can be tricky, it helps to have peace of mind. Today, I thought I would be giving myself peace of mind and instead, I ended up saving us from a terrible awful mistake.

 

I've blood tested 3 times. Ninja doesn't seem to mind it too awful much. What he hates is the shots!! He fights me on that one.

I had mentioned earlier that Ninja doesn't eat much. I ordered some Evo Chicken and Turkey and it arrived today. I gave him some of it and you would have thought it was Christmas. He ate it like he was starved. . . . which I guess that kinda true. Do I need to limit how much I give him?

 

If he's underweight you don't have to skimp on food. However, they usually do better with several small meals instead of fewer large ones. Grazing is fine too so long as food is removed 2 hours before pre shot BG tests.

 

Thanks, Kris. I let him eat a fair amount because he needs to gain weight. However, I don't plan to let him free feed on it very much. I want to stick with canned food. I feel that is better for his condition.

 

Good to know the ketones are negative and Ninja was chasing squirrels. Sounds like he is feeling better. The ketone strips can be very time sensitive so make sure you pay attention to the time frame specified on the bottle when reading the results.

The canned food is definitely better but for now you could leave out a bit of the dry for grazing as it is a low carb option if he will eat it more readily than canned. The EVO Turkey and Chicken dry is very calories dense so it should help him put on some weight.

 

I agree about feeding canned food. My guy doesn't free feed either. He gets 4 scheduled meals a day.

 

Love, love, love your video!!